Recently our Hamilton Spectator published two op eds side by side. One espoused going back to the moon and staying there (a permanent research settlement), and the other argued for Mars. I pondered the short-sighted craziness of this at the time but it didn’t come into stark relief until I saw the news item that India had just launched a rocket to send a rover to the moon, specifically to one of the lunar poles.
India.
70 percent of the population of India does not have access to toilets. They urinate and defecate in the open. Might not that be a higher priority? Of course the people at greater risk with no plumbing are poor women and poor children, not politicians, engineers and scientists and the CEO’s of the new private space industry.
For humankind to aim for a colonization of the moon and/or Mars implies a great endeavour, a great adventure, requiring enormous resources and cooperation. Presumably this endeavour would be led by NASA, with the help of Canada and numerous private companies. And then one day in the future we can all be staring at our TV screens, this time 55 inch 4K LED screens, when the first astronaut of this century takes that one giant leap for mankind. But we better be watching indoors because it will be too hot and stormy outdoors and we better have strong locks on those doors because there will be millions of people from now uninhabitable parts of this earth trying to get in.
Last night I watched part of a pleasant CBC production telling me how I might reduce my carbon footprint. Right down to how many times I have to re-use a glass bowl before it becomes better than disposable styrofoam. Guilt inducing, quaint, nicely Canadian, but oh so silly.
And then I read an article about how many trees I need to plant each year to cover just my own personal carbon output. There was some disagreement on the numbers but on the low end it almost looked doable, that is if each of us had the space and resources to plant 400 trees with life spans of 80 plus years.
So, it looks like extinction for the human race, and most animals, within a few generations, preceded by years of crises, suffering, and conflict, if we, collectively, don’t reduce and control our CO2 emissions.
And here is the question: Why on earth can we not turn those space travel resources into a “Manhattan/NASA” project to save the world? Bring together all the management skills, engineering skills and scientific knowledge in one place (of course today it doesn’t have to be physically one place) to come up with the best possible comprehensive plan. We are (some would say we have run out of time) running out of time for our grandchildren.
And sure, include world wide education for how each of us can personally reduce our carbon footprint, and of course tell us how we can move quickly to non carbon producing forms of energy, but also take a realistic view of natural sequestration of carbon (trees), and all the proposed and possibly viable artificial means of capturing carbon and either burying it or using it. And in this mix don’t forget population control.
We humans have a very poor track record when it comes to self denial for the sake of the human race, but we can be quite astonishing when we decide to build something, or do something never done before, or repair something, or save something. This time it is the planet we need to save. Let’s get on with it.

An unusual connection of topics in the headline, I admit, but let me explain. We live in an era of political correctness gone mad to the point that I’ve been lambasted in the past for saying schizophrenic rather than a person with schizophrenia. I actually did a column years ago entitled something like sticks and stones….. where I discussed the silliness of terminology and the editor got letters of complaint.

Years ago, Dr Sally Satel wrote a book called PC, M.D.: How Political Correctness Is Corrupting Medicine I loved that book and wish I could remember who I loaned it to. I am a big fan of hers for many reasons and one is her sensible attitude to treatment and committal for those with serious mental illness.

Political Correctness just turned up in Ontario when a political cartoonist published a bang on cartoon of Ontario cabinet minister Lisa MacLeod. The cartoonist in this case was Michael De Addar whose recent Trump cartoon went viral and he was fired from his freelance gig. If you visit the link above, you will see the Trump cartoon that got him fired.

In that link, De Adder describes the role of a political cartoonist and the top role is sarcasm or, as the Brits say, to take the piss out of people. That is what he does and political cartoonists have always done that well.

After being fired, he was picked up by the Toronto Star which has a long history of brilliant political cartoonists. His first cartoon for them got him in trouble again for making fun of the mentally ill but called mental health issues because to call someone mentally ill is not politically correct.

Some background. Most people are familiar with the late Rob Ford who became mayor of Toronto as his antics with drugs made headlines around the world. His big brother Doug desperately wanted to follow him as mayor but he was trounced. He managed to become leader of the Ontario Conservative Party when they turfed their leader and entered the election in 2018 when the incumbents had been in office for so long that their approval rating was rock bottom.

Doug won with no platform and immediately began cutting services for everyone. His minister, Lisa MacLeod, tried to reform the treatment programs for the autistic (persons with autism) and their families and was greeted with jeers, disdain, and numerous protests. The governments’ popularity fell to unprecedented levels within a year (60% surveyed reported July 15 that they felt the government was corrupt) so that in desperation, Doug demoted most of his cabinet and had them replaced.

The lady who messed up the autism file is now the Minister of Tourism, Culture and Sport and she went to see the Rolling Stones at their recent concert in Ontario. While there, she spotted Eugene Melnyk, the owner of the Ottawa Senators hockey team (and Ms MacLeod comes from Ottawa). She went up to him and said:

“Do you know who I am?” and, “I am your minister and you’re a f—ing piece of s—t and you’re a f—ing loser’.”

She later apologized on twitter but De Adar’s cartoon showed her in a straight jacket being led away by two men in white coats.

None of this upsets me as someone with mental illness in the family and who has written and advocated for years for better treatment. It did upset many who felt that the cartoon promoted stigma for the mentally ill and made it more difficult for people to get help.

Camille Quenneville, CEO of the Canadian Mental Health Association, stated so well in a letter to the editor published in the Star in protest of the de Adder cartoon:

“The cartoon depicting the Hon. Lisa MacLeod in a straitjacket is heartbreaking and demoralizing for all of those suffering, and the people supporting them. I cannot imagine the Star printing a cartoon maligning a cancer patient.”

The Star’s public editor in the link above, agreed. It seems that some people knew that Ms MacLeod had once mentioned that she had problems with depression and anxiety and so this was an unfair attack on her and on the mentally ill.

What is unfair is the lack of treatment services for those with serious mental illness. That upsets me. Not an attack on a politician who was caught trying to throw her weight around and invoke her self believed power over others. The fact that she has had an issue with depression in the past is no excuse to cut her some slack.

And suggesting she be carted off in a straight jacket is simply the sarcasm of a political cartoonist popping the balloon of a self important politico.

Sarcasm from the Oxford English Dictionary is “The use of irony to mock or convey contempt.” The target of that contempt was a politician and not those with mental illness.

If people want to become incensed about our attitudes to mental illness, they should start to demand to know why so many are untreated, homeless and/or in jail. That is the obscenity!

I do not understand the term “co-causal”. In the study of disease we look for necessary etiological factors, contributing factors, and protective factors. For TB it is necessary to be exposed to a certain micro-organism. Contributing factors include crowding, poor ventilation, poor immune system, poor nutrition. Protective factors include excellent immune system, robust health, hygiene, fresh air.

“Trauma” is a loaded word. It generally infers a major assault on one’s body, brain, mind. When the word is used it is understood in this way. A diet excessively rich in carbohydrates causing a particular messenger protein to be manufactured and released by mitochondrial DNA and then influencing the genes that are scheduled to turn on or turn off other genes during future developmental phases is not, in usual parlance, a “Trauma.”

And finally, with respect to statistics and scientific journals: There was a time I think when only the scientists and medical professionals read these articles, and generally they knew how limited, usually, each was in establishing an ultimate truth. Each depended on a specific population studied, on particular definitions, particular measures of outcome, experimental bias, reader bias, uncontrolled variables. We also always knew that null studies do not get published.

Now the selective summaries of these studies show up in newpapers and google if they “find something”.

It has been of interest to me as a male Canadian of European descent to learn definitively if it is healthier to partake of no alcohol, red wine only, one, two, three, or four drinks per day. So I confess that I read these studies more often than studies on “schizophrenia and trauma.”

Given the large numbers of people who drink alcohol and the large numbers of people who drink none, it really should be easy to answer my question. Much easier than tracking down “co-causal” intrauterine factors in the development of schizophrenia.

Yet despite the money and interest in the alcohol question, large population studies, and definitive statements in the press, we still know (scientifically) little more than my grandmother who preached “moderation.”

The studies cited by Bruce Wilson do not demonstrate a causal relationship between childhood trauma (neglect, abuse, deprivation, sexual abuse) and schizophrenia. They do, quite logically, demonstrate a relationship between childhood trauma and severity of the course of schizophrenia. That is, the specific injuries to cognitive developmental processes, focus, attention, arousal systems, and affective pathways in the brain caused by serious childhood neglect and/or abuse, (if this person later develops schizophrenia or bipolar disorder), cause a more refractory and debilitating form of the illness. The trauma experienced may also shape the nature and form of the symptoms.

Abuse and neglect in childhood make schizophrenia worse.

And then we have “Lies, damn lies, and statistics”:

Some studies show, for instance, when adults are hospitalized with a diagnosis of schizophrenia, and asked or surveyed about childhood trauma (specifically physical abuse, emotional abuse, emotional neglect, physical neglect, sexual abuse) they answer in the affirmative between 7 percent for sexual abuse and 13 percent for emotional neglect and a total of 49 percent overall. Now these figures turn out to very similar to the same percentages we find when we survey the entire population. In fact when the definition of trauma is expanded to include major losses, bullying, witnessing a death, the percent of the general population answering in the affirmative is more than 80% even in countries like the US.

In the general population 15 to 25% of women and 14% of men report being sexually abused as children or teens.

So if I simply take these figures from legitimate studies I could make a case that a smaller percentage of people suffering from schizophrenia report being abused than the general public. (e.g., for sexual abuse, 7% of schizophrenics vs. 15%+ of general population) . At the very least I can certainly say that these studies do not show a causative link between abuse and schizophrenia. In fact I can use these figures to support the opposite conclusion.

But for years it has been known that identical twins raised in the same household are only concordant for schizophrenia 60 to 80% of the time. This does imply that an environmental influence could make a difference for 40 to 20%. (My own small sample of identical twins (2) with schizophrenia over 50 years places concordance at 100%)

But if the twins are raised in the same household they must have had similar environments and experiences through childhood and adolescence. It is rather inconceivable that one identical twin was abused and/or neglected and the other not.

So this presented a puzzle.

But now we know that a.) 99.7 percent of the DNA of every human is identical, b.) that human DNA is 96% percent the same as that of chimpanzees and c.) identical twins do not have exactly the same DNA and d.) expression of any gene can be influenced by many factors (including other genes), many of which are probably intrauterine. For example, identical twins can develop similar but not identical finger prints.

Epigenetics and environmental factors certainly play a role in the onset, development and the course of any genetic illness. There also always have been, and continue to be, problems, differences, and great variability in the diagnosis of schizophrenia, making most surveys involving this diagnosis suspect. And the onset of trouble (early symptoms) can be well hidden in a protective, adaptive environment, or explode early in a troubled home.

And it is my experience that the immediate “environmental factors” that precipitate a full blown schizophrenic psychosis in a person genetically vulnerable to schizophrenia are not “traumas”, but (besides drug use) rather common, normal, usual developmental social stresses: Attending high school, leaving home to live on campus, share a student house, first job, first date, first relationship, first child, even the push and expectation to advance developmentally and socially…

And by the time identical twins reach the age of schizophrenia onset there may easily have been a sufficient number of different epigenetic and environmental factors to offer, 20% of the time, protection for one and not the other. (And a more productive line of research might be to figure out what those protective factors are)

As I have been reminded recently, serious trauma in the first few years of life (neglect, deprivation, abuse, sexual abuse) causes enormous damage that is readily apparent in the years of childhood and adolescence long after the child has been rescued. Let us not trivialize this level of trauma by including disappointment, unhappiness, failure at sports, having to change schools, growing up poor, name calling, loss of a friend, or even of a parent, under the rubric of TRAUMA.

“People with psychotic illness do not need someone probing the wells of their psychic discomfort; they do not need (no matter how well-intended) a therapist scouring their childhood memories in search of an unhealed wound. They need support, safety, security, grounding, and satisfying routine before they can get better. And good medical treatment.”

That actually happened to the person who wrote the article I recommended.

I also recommend a second blog that he did when he was criticized for his view that trauma does not cause serious mental illness.

Another recent good article on the topic just appeared in a UK paper by Alastair Kemp and Ruth Hunt called the Traumatic Power Struggle Within Mental Health. They argue that ideological differences are being used to cut services. If the problem is simply trauma and not biological then the sick need to take responsibility for their problems and their failure to get well. If they don’t, why give them government supports?.

Another good paper is by Dr Boris Vatel, a psychiatrist at the Indiana State Hospital in Evansville, IN called Unmasking trauma-informed care which appeared in Current Psychiatry Archives, October 9, 2015. He points out that:

trauma-informed care has no language for dividing pathology from normality and because everyone’s experience and pain are seen as equally “valid,” trauma-informed care actually trivializes severe trauma by placing it on par with experiences that objectively would be classified as merely unpleasant.

Now, if trauma causes serious mental illness, then I should have schizophrenia.

I don’t!

I grew up in Toronto as the child of poor, working class, Jewish immigrants at a time when Toronto was not the tolerant wonderful multi-cultural city it is today. Then, my father died when I was 10 and I had a number of serious medical problems. I remember my uncle taking me to a synagogue, introducing me to the sextant and telling me that he would look after me while I was there. I actually thought I was going to be living in the synagogue with this garlic smelling guy with the numbers tattooed on his arm. That was traumatic.

It turned out that I did not have to live there but no one told me that I would have to go to morning and evening prayers for a year to say the mourners prayer instead of playing with my friends (traumatic). The Rabbi partly saved me by telling me I did not have to come for morning prayers.

Allow me to look at all the people with schizophrenia and/or their families whose books I’ve published.

I am not so naive that I do not believe that prosperous, educated people do not abuse their kids or that their kids cannot suffer trauma but there was no trauma in these cases.

Susan Inman in Vancouver wrote After Her Brain Broke about her experiences with her daughter who developed schizophrenia. Susan was a teacher and her husband a university professor and there are no signs in her book that her daughter suffered any trauma. What was traumatizing for her daughter and for the family was the counselor they hired to help her daughter. The counselor was one of those who believed in the trauma theory, grilled the young lady on potential traumas she may have experienced and even set back the proper treatment by her actions.

Sandra Yuen MacKay (My Schizophrenic Life) developed schizophrenia at a fairly young age despite being in what seems to have been a loving Chinese-Canadian family. Her father was an architect and Sandra has gone on to become a very successful artist. She is the winner of the Courage to Come Back Award in Vancouver, one of the faces of mental illness in Canada, and exhibits her work in the Vancouver area. No signs of trauma.

Erin Hawkes-Emiru (When Quietness Came) came from the Maritimes and became sick while a student at Dalhousie University in Halifax. Her mother is a librarian and her father a university professor with the only signs of trauma being the trauma to Erin of having difficulty finding a medication that worked for her in her adventures with horrible psychosis from Dalhousie University to the University of British Columbia. I lost count of the number of times the police had to wrestle her into ambulances for another trip to the isolation ward.

Erin’s doctors finally found an anti-psychotic that worked; she completed her masters in neuroscience, is a peer counselor in Vancouver and speaks to conferences of families, doctors, nurses and others. She too is a Courage to Come Back winner.

The late Dr Carolyn Dobbins (What A Life Can Be) spent a childhood engaged in sports and was about to qualify for the US Ski Team at Lake Placid when she became ill. Carolyn did manage to get her PhD in psychology from Vanderbilt despite her illness and was a successful counselor for many years. She grew up initially in Colorado but then her family moved to Knoxville where her father was a practicing pediatrician. A childhood friend, Dave Kopel, wrote an extensive review of her book in his blog at the Washington Post

Carolyn mentions no trauma whatsoever in her childhood other than the trauma of her disease that severely impacted her life. Unfortunately, she passed away early but she lives on in her book which is still very popular.

There was also no trauma in the life of Sakeenah Francis (Loves All That Makes Sense) other than being African American in a racist society. Her parents were educated citizens in Cleveland and Sakeenah attended an African American University where she met and married her husband. It was after she married that she developed schizophrenia. She and her mother had differences when she was growing up but so do many people who did not develop an illness. Her family was incredibly supportive as so many families are. She was able to return the favour by helping look after her father when he developed Alzheimer’s.

The one person with schizophrenia whose story I’ve published is Paul Flannery (Shot in the Head) whose story and the history of the family was written by his sister. Paul developed schizophrenia in his mid-teens and never properly recovered for a host of reasons. This very large Irish American family was highly supportive and there is no indication of any severe trauma that might have triggered the disease as the trauma proponents claim. Paul’s twin did not develop the condition even though there is a high likelihood that twins will.

My own personal experiences also disprove the trauma theory but I have to comment on one of the stupid suggestions we got from a social worker and psychologist before the proper diagnoses. Seems my son was suffering from being in a family where there was too much love. We were stunned by that comment and still are today. And my son has told me how happy his childhood was. The day we were told the too much love story, my son admitted in the session that he had been using a lot of marijuana. As David pointed out in his blog “Involve Parents”, this is not unusual. Our son told us that we were pretty stupid not to have noticed and pointed out how he always cleared out the fridge when he got home from being out with friends.

Earlier this week, I met with the Alzheimer’s patient I am power of attorney for and with his new doctor. No one ever mentions trauma as a cause of Alzheimer’s which, like schizophrenia, is a disorder of the brain but with no therapeutic options unlike schizophrenia. As with schizophrenia, signs of paranoia are creeping into his symptoms.

The vast majority of parents stand by and support their kids and endure tremendous stress and often cost while doing so. As an example, when I was involved with the local chapter of the Schizophrenia Society of Ontario, we had an annual golf day put on for us by the National Hockey League Old Timers. They were an incredible bunch of generous characters. One of our members, a fairly elderly woman, would stand at the 1st tee all day to lecture each foursome on schizophrenia and the importance of supporting us. It was a very hot day and she did not move to so much as get a drink or to pee for fear of missing a foursome.

Isn’t it about time we put this stupid theory into the garbage where it belongs.

The other night on the Bill Maher show Adam Gopnik warned of the threat to liberal democracy that Donald Trump presents. He also said that the democratic candidates arguing about what are usually the important issues (health care e.g.) normalizes Trump’s behaviour. If they don’t focus on that they are saying it is just politics.

We all recently saw Trump make a joke about telling Putin to not interfere in American Elections. We all saw him legitimize the cruel dictatorship of Kim Jong Un and suggest in conversation with Putin and by his friendship with The Crown Prince of Saudi Arabia that killing off journalists is not such a bad thing.

But a small exchange between Trump and another journalist was perhaps the most chilling of all. The journalist asked Mr. Trump what he was going to discuss with Putin. And Donald Trump answered, “None of your business.”

And that small exchange embodied the threat to democracy Trump poses. For clearly Donald Trump does not see himself as an elected representative of the people with a four to eight year appointment to that position. He is, in his mind, a potentate, a king, a ruler, a despot, a chosen one, a single being more important than the populace, the populace that is allowing him to temporarily represent them. He does not understand democracy.

And then in Canada I see a cartoonist was fired, presumably for a cartoon depicting Donald golfing by the edge of the Rio Grande and coming across the bodies of Oscar Ramirez and his daughter Angie. The caption read, “Do you mind if I play through?”

Gopnik rightly suggests America is at a turning point; the only issue for 2020 is defeating Donald Trump before they lose their democracy. And the democratic candidates need to focus all energy on this.

And I mention the cartoonist because I think, I believe, that of all the freedoms we have in a democracy, the most important, and the freedom that provides the strongest bulwark against tyranny is not just the freedom of speech, good journalism, the fourth estate, but the freedom to complain, criticize, and most importantly, make fun of our leaders and deities.